For years, I have written about consolidation in healthcare — how mergers of hospital systems, insurers, and service providers have squeezed competition, raised costs, and eroded patient care. When one company dominates a product or a region, the entire system suffers.

Here is another example worth examining: the electronic health record (EHR) vendor Epic Systems.

Epic’s name is nearly synonymous with health information technology (IT) and EHRs in this country. Its software touches the majority of large health systems and a significant proportion of U.S. hospital beds. In fact, as of 2024, the latest year for which data is available, Epic commanded 42% of the acute care EHR market, a 3% increase from 2023. In 2024, Epic had a record year, becoming the only EHR provider to gain hospital contracts that year. As a result, Epic’s databases house more than 325 million patient records, representing 90% of people in the U.S. (if it represents individuals).

That dominance has given Epic tremendous power — power to shape and control clinical workflows, to influence standards for interoperability, and now, power to reshape nascent markets like artificial intelligence (AI)-powered documentation.

The questions are now: has Epic become too big to fail? And is widespread EHR consolidation a good thing?

A Wolf in Sheep’s Clothing?

In January, Epic filed a federal lawsuit against Health Gorilla, a Qualified Health Information Network, and several other parties, alleging they improperly accessed nearly 300,000 patient records through national interoperability frameworks under dubious pretenses and then exploited and monetized the data outside legitimate care needs.

Epic and its provider partners argue these actions threatened patient privacy, the integrity of data exchange, and trust in interoperable systems.

In its filings, Epic positioned itself as a protector of patient privacy, but the lawsuit raises troubling questions about who gets to control health data, how interoperability actually works, and whether the vendors that dominate the infrastructure are acting as stewards of patient data — or gatekeepers to it.

Epic’s actions shined a spotlight on the competitive imbalance in health tech that increasingly resembles monopoly behavior rather than fair participation.

Consolidating Power Through AI

The lawsuit is not Epic’s only apparent attempt to crowd out competition.

In early 2026, Epic launched its own AI charting tool, a built-in, ambient scribe to draft clinical documentation directly within the Epic EHR. This move will likely have broad implications across the $1 billion ambient AI scribe market — a space once dominated by startups like Abridge, Ambience, and others.

But if Epic’s presence simply absorbs existing market demand, what happens to independent innovators? What happens to smaller companies pushing new ideas, better interfaces, or tools tailored for specialty workflows? When the largest EHR vendor decides it will own the AI assistant space, will all other AI scribes be shut out?

It appears to me that Epic’s ambient scribe move may be about control of data, access to markets, and the power to control fragmented clinical workflows. Epic already controls a substantial share of acute care EHR deployments. When it bundles AI tools into its core product and prices them aggressively, the platform gains significant leverage. We see this pattern in other sectors with dominant platforms. When companies like Google, Microsoft, and others control the technology doorway, they set the terms, pick winners, and decide who participates and at what price.

Monopolistic Behavior Can Harm Patients

In healthcare, the cost of consolidation and monopolies goes beyond economic costs. The human cost is particularly high, affecting provider choice, patient experience, clinician satisfaction, patient privacy, and even patient safety.

Consider the lawsuit mentioned above. Epic alleges misconduct on the part of Health Gorilla’s network participants. But Health Gorilla pushed back on Epic, claiming Epic’s actions, including past disconnections of data exchange partners, reflect an “attack on interoperability,” limit the flow of information for reasons beyond patient safety, and raise concerns about “monopolistic” practices in the industry. Interoperability frameworks like Carequality and Trusted Exchange Framework and Common Agreement rely on trust: systems exchange data because they ought to, in the service of better care. When a dominant player uses litigation to potentially assert control over access methods and participants, the governance of data exchange, which is already fragile and inconsistent, weakens further.

Take accuracy. When one company dominates clinical records, integration and security risks multiply. (A great example is the 2024 Change Healthcare cyberattack.) Faults or gaps in that dominant system ripple outward.

Epic’s move into ambient AI scribes does not automatically equate to better outcomes. Technical advances such as real-time transcription offer promise, but they also bring new challenges: errors in AI-generated clinical notes could introduce safety risks if left unchecked. (Indeed, research has surfaced concerns about AI scribe accuracy and clinical risk, especially when models are applied in nuanced specialties like psychiatry or oncology.)

When a single vendor’s tool becomes the de facto standard, the diversity of solutions that might better serve specific patient populations or provider needs shrinks.

Is Anyone Watching?

A broader systemic risk exists here, too. Healthcare consolidation in hospitals and insurers has long drawn scrutiny because it diminishes competition, increases prices, and concentrates power. Yet, EHR vendors have quietly become some of the most powerful intermediaries in the healthcare ecosystem. With near-total control of how records are captured, stored, and exchanged, vendors like Epic operate with an authority that far outstrips any individual hospital or clinic.

Are we comfortable letting a single vendor or a small handful of vendors define the rules of engagement for interoperability, AI innovation, and clinical documentation? If Epic’s decisions become the baseline for how patient data must flow and how clinicians must document care, then we have arguably set up a system that prioritizes control over choice, dominance over diversity, and scale over safety and competition.

One might respond that Epic has earned its position through performance and reliability. But market dominance should not be conflated with moral authority. A system that incentivizes one vendor to subsume markets — to absorb emerging tools by developing its own versions — ultimately reduces consumer choice and limits innovation. Startups and smaller companies are where much of the healthcare innovation energy lives. If they are systematically priced out or compelled to build around the platform of a single dominant player, our collective capacity to improve care will be diminished.

Regulators and providers should rethink how interoperability is governed, how clinical data exchange is overseen, how entrepreneurs can innovate, and how competitive markets are preserved in digital health infrastructure. True interoperability goes beyond moving wires and pipes that move data. Interoperability and accessibility have accountable governance and a marketplace where multiple solutions can thrive.